Routine bronchoscopy useful in phenotyping and personalized asthma management

It is already known that SUA is treated with biological therapy if a T2 phenotype is found. Routine bronchoscopy is not a frequent recommendation in such patients. The Research question is, “Is there safety and useful in phenotyping and endotyping SUA patients before indicating biologic therapy when it comes to routine bronchoscopy?”

To answer this and elucidate further, researchers did a Prospective study of consecutive SUA patients phenotyped as T2-allergic, T2-eosinophilic and non-T2. All the relevant findings were recorded, and Cluster analysis was performed.

The study results could be summarised as follows:

• Researchers recruited 100 patients.
• Patients were classified as T2-allergic (28%), T2-eosinophilic (64%) and non-T2 (8%).
• On bronchoscopy, the signs of gastroesophageal reflux disease, vocal cord dysfunction and tracheal abnormalities were detected in 21%, 5% and 3%.
• BAS culture isolated bacteria and fungi in 27% and 14% of patients.
• Three clusters were identified: non-specific, upper airway, and infection, the latter less frequently associated with submucosal eosinophilia.
• Considering bronchial biopsies, 91% got eosinophils detected.
• Five patients with T2 phenotypes in a bronchial biopsy showed no eosinophils, and 3 with non-T2 showed eosinophils.
• Moderate bleeding was reported in only one patient.

The lead researcher Prof. Dr Borja G Cosío, MD, PhD, Respiratory medicine department, said, “Our study’s findings prove the safety of Routine bronchoscopy in SUA eligible for biologic therapy, and it can be helpful in phenotyping and personalized asthma management.

Further reading:

Redefining the role of bronchoscopy in the work-up of severe uncontrolled asthma in the era of biologics: a prospective study. https://doi.org/10.1016/j.chest.2023.03.012